title: The clinical impact of early complete pancreatic head devascularisation during pancreatoduodenectomy.
abstract: BACKGROUND
  Early inferior pancreaticoduodenal artery (IPDA) ligation reduces intraoperative blood loss during pancreatoduodenectomy, but the impact on oncologic and long-term outcomes remains unknown. The aim of this study was to review the impact of complete pancreatic head devascularization during pancreatoduodenectomy on blood loss, transfusion rates, and clinicopathologic outcomes.
  
  
  METHODS
  Clinicopathologic and outcome data were retrieved from a prospective database for all pancreatoduodenectomies performed from April 2004 to November 2010 and compared between early (IPDA+; n = 62) and late (IPDA-; n = 65) IPDA ligation groups.
  
  
  RESULTS
  Early IPDA ligation was associated with reduced blood loss (394 ± 21 vs 679 ± 24 ml, P < .001) and perioperative transfusion (P = .031). A trend toward improved R0 resection was seen in patients with pancreatic adenocarcinoma (IPDA+ vs IPDA-, 100% vs 82%; P = .059), but this did not translate to improved 2-year (IPDA+ vs IPDA-, 76% vs 65%; P = .426) or overall (P = .82) survival.
  
  
  CONCLUSIONS
  Early IPDA ligation reduces blood loss and transfusion requirements. Despite overall survival being unchanged, a trend toward improved R0 resection is encouraging and justifies further studies to ascertain the true oncologic significance of this technique.
authors.affiliation: Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, University of Sydney, St Leonards, Australia.
authors.forename: J S
authors.initials: JS
authors.lastname: Gundara
authors.forename: F
authors.initials: F
authors.lastname: Wang
authors.forename: R
authors.initials: R
authors.lastname: Alvarado-Bachmann
authors.forename: N
authors.initials: N
authors.lastname: Williams
authors.forename: J
authors.initials: J
authors.lastname: Choi
authors.forename: S
authors.initials: S
authors.lastname: Gananadha
authors.forename: A J
authors.initials: AJ
authors.lastname: Gill
authors.forename: T J
authors.initials: TJ
authors.lastname: Hugh
authors.forename: J S
authors.initials: JS
authors.lastname: Samra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control* / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D010179:Pancreas / Q000098:blood supply*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011446:Prospective Studies; D012737:Sex Factors
keywords: Artery first; IPDA; Inferior pancreaticoduodenal artery; Pancreatoduodenectomy